AAFP, Others Call on Congress to Extend Parity Program

Delayed Rollout of Medicaid-Medicare Program Causing Frustration

The provision in the Patient Protection and Affordable Care Act that creates payment parity between Medicaid and Medicare was welcomed by family physicians and the AAFP when it was first introduced in 2012, but delayed implementation at the state level has caused concern for many family physicians. Now, the AAFP and other organizations are calling on Congress to extend the program for two years so it can be more effectively evaluated.

The program, which is scheduled to end in December 2014, brings Medicaid payments for certain primary care services up to at least Medicare levels for 2013 and 2014. Although the program began in January, many states were not ready to implement it, and, thus, some physicians treating Medicaid patients have not yet received the higher payment amounts.

"The extension is particularly important because its slow startup -- with many states only now beginning to pay at the higher Medicare rates -- combined with a lack of assurance that it will be extended beyond 2014 has not allowed an adequate enough time to demonstrate the program's effectiveness in improving access," said the coalition letter from the AAFP(3 page PDF), American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, and American Osteopathic Association.

"The policy of increasing Medicaid payment rates to no less than the comparable Medicare payments is based on well-established research that shows that low Medicaid payment levels in many states (are) associated with fewer physicians accepting large numbers of Medicaid patients into their practices, resulting in reduced access to persons covered under Medicaid."

The groups pointed out that if the program is allowed to expire, it will create obstacles for patients looking for a patient-centered medical home. Improving access to physicians for Medicaid patients will lead to better care and decreased costs, they said, noting that many physicians currently do not take Medicaid patients because the payment rate is below the cost of providing care. "This results in reduced access to care for the most vulnerable patients and higher costs to federal and state governments," said the organizations.

In addition to their call for a two-year extension of the Medicaid primary care payment increase, the organizations also asked that Congress include physicians practicing obstetrics and gynecology as qualified specialists in the parity program, as long as they can meet the eligibility requirement that at least 60 percent of their Medicaid billings are primary care services defined by the authorizing legislation.

"We believe that inclusion of physicians practicing obstetrics and gynecology in the extension is integral to achieving the intended purpose of the Medicaid primary care payment increase," said the groups. "For many women, an OB-Gyn is the only physician they see regularly during their reproductive years and the only point of entry into the health care system."